Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 1 of 11CrR 4 .2 (g ) ( 0 8/2 016)Superior Court of WashingtonforState of Washington , Plaintiff v. . Defendant No.Sta te m en t o f D efe n dan t o n P le a o f
Gu ilt y t o N on -S ex O ffe n se(F elo n y)(S TTD FG )1. My t r u e n am e i s : _ ___________________________ __________________________.2 . My a g e i s : _ _________ _________________________.3 . The l a st l e v el o f e d ucatio n I c o m ple te d w as: _ ______ _________ .4. I H av e B een In fo rm ed a n d F ully U nders ta n d T hat: (a ) I h av e t h e r ig ht t o r e p re se n ta tio n b y a l a w yer a n d i f I c an not a ffo rd t o p ay f o r a l a w yer, o ne
will b e p ro vid ed a t n o e x pen se t o m e.(b ) I a m c h arg ed w ith : . The e le m en ts a re :
.
5 . I U nd ers ta n d I H ave t h e F ollo w in g Im porta n t R ig hts , a n d I G iv e T hem U p b y
Ple ad in g G uilt y : (a ) The r ig ht t o a s p eed y a n d p ublic t r ia l b y a n i m partia l j u ry i n t h e c o unty w here t h e c rim e
wa s a lle g ed ly c o m mitte d ;(b ) The r ig ht t o r e m ain s ile n t b efo re a n d d urin g t r ia l, a n d t h e r ig ht t o r e fu se t o t e stif y a g ain st
my se lf ;(c ) The r ig ht a t t r ia l t o h ear a n d q uestio n t h e w itn esse s w ho t e stif y a g ain st m e;(d ) The r ig ht a t t r ia l t o t e stif y a n d t o h av e w itn esse s t e stif y f o r m e. T hese w itn esse s c an b e
ma d e t o a p pear a t n o e x pen se t o m e;(e ) The r ig ht t o b e p re su m ed i n nocen t u nle ss t h e S ta te p ro ves t h e c h arg e b ey ond a r e aso nab le
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 2 of 11CrR 4 .2 (g ) ( 0 8/2 016)dou bt o r I e n te r a p le a o f g uilty ; (f) The r ig ht t o a p peal a f in din g o f g uilt a fte r a t r ia l. 6 . In C onsid erin g t h e C onseq uen ces o f M y G uilt y P le a, I U nders ta n d T hat:
(a) My r ig ht t o a p peal i s l im ite d .(b) Each crime with which I am charged carries a maximum sentence, a fine, and a
Standard Sentence Range as follows:COUNT NO.OFFENDER SCORESTANDARD RANGE ACTUAL CONFINEMENT (not including enhancements)PLUS Enhancements*COMMUNITY CUSTODYMAXIMUM TERM AND FINE123*The sentencing enhancement codes are: (RPh) Robbery of a pharmacy, (CSG) Criminal street gang involving minor, (AE)
Endangerment while attempting to elude. The following enhancements will run consecutively to all other parts of my entire
sentence, including other enhancements and other counts: (F) Firearm, (D) Other deadly weapon, (V) VUCSA in protected
zone, (JP) Juvenile present, (VH) Veh. Hom., see RCW 9.94A.533(7), (P16) Passenger(s) under age 16. (c ) The s ta n dard s e n te n ce r a n ge i s b ase d o n t h e c rim e c h arg ed a n d m y c rim in al h is to ry .
Cr im in al h is to ry i n clu des p rio r c o nvic tio ns a n d j u ven ile a d ju dic atio ns o r c o nvic tio ns,
wh eth er i n t h is s ta te , i n f e d era l c o urt, o r e ls e w here . ( d ) The p ro se cu tin g a tto rn ey 's s ta te m en t o f m y c rim in al h is to ry i s a tta ch ed t o t h is a g re em en t.
Un le ss I h av e a tta ch ed a d if fe re n t s ta te m en t, I a g re e t h at t h e p ro se cu tin g a tto rn ey 's
sta te m en t i s c o rre ct a n d c o m ple te . I f I h av e a tta ch ed m y o w n s ta te m en t, I a sse rt t h at i t i s
co rre ct a n d c o m ple te . I f I a m c o nvic te d o f a n y a d ditio nal c rim es b etw een n ow a n d t h e t im e
I a m s e n te n ced , I a m o blig ate d t o t e ll t h e s e n te n cin g j u dge a b out t h ose c o nvic tio ns.(e) If I committed the above crime(s) while under age 18 and am sentenced to more than 20
years of confinement: (i)As long as my conviction is not for aggravated first degree murder or certain sex
crimes, and I have not been convicted of any crime committed after I turned 18 or
committed a disqualifying serious infraction as defined by DOC in the 12 months
before the petition is filed, I may petition the Indeterminate Sentence Review Board
(Board) for early release after I have served 20 years. (ii)If I am r ele a se d e arly b ecau se m y p etitio n w as g ra n te d o r b y o th er a ctio n o f t h e B oard ,
I w ill b e s u bje ct t o c o m mun ity c u sto dy u nder t h e s u perv is io n o f t h e D OC f o r a p erio d
of t im e d ete rm in ed b y t h e B oard , u p t o t h e l e n gth o f t h e c o urt- im pose d t e rm o f
in carc era tio n. I w ill b e r e q uir e d t o c o m ply w ith a n y c o n ditio ns i m pose d b y t h e B oard .(iii) If I v io la te t h e c o nditio ns o f c o m munity c u sto dy, t h e B oard m ay r e tu rn m e t o
co n fin em en t f o r u p t o t h e r e m ain der o f t h e c o urt- im pose d t e rm o f i n carc era tio n.(f) If I c o m mitte d a g gra v ate d m urd er i n t h e f ir s t d eg re e a n d I w as u nder t h e a g e o f 1 8 a t t h e
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 3 of 11CrR 4 .2 (g ) ( 0 8/2 016)tim e o f t h e o ffe n se .(i) If I w as u nder t h e a g e o f 1 6 a t t h e t im e o f t h e o ffe n se , t h e j u dge w ill i m pose a
ma x im um t e rm o f l if e a n d i m pose a m in im um t e rm o f t o ta l c o nfin em en t o f 2 5 y ears f o r
th at c rim e.(ii) If I w as a t l e ast 1 6 b ut l e ss t h an 1 8 y ears o ld a t t h e t im e o f t h e o ffe n se , t h e j u dge w ill
im pose a m ax im um t e rm o f l if e a n d w ill i m pose a m in im um t e rm o f t o ta l c o nfin em en t
th at i s a t l e ast 2 5 y ears a n d m ay b e a s l o ng a s l if e w ith out t h e p ossib ility o f p aro le o r
ea rly r e le ase f o r t h at c rim e. ( iii) D urin g t h e m in im um t e rm , I w ill n ot b e e lig ib le f o r e arn ed e arly r e le ase t im e, h om e
de te n tio n, p artia l c o nfin em en t, w ork r e le ase , o r a n y f o rm o f e arly r e le ase .(iv ) A fte r t h e m in im um t e rm , i f I a m r e le ase d b y t h e B oard , I w ill b e s u bje ct t o c o m munity
custo dy u nder t h e s u perv is io n o f t h e D OC f o r a p erio d o f t im e d ete rm in ed b y t h e
bo ard , a n d m ust c o m ply w ith c o nditio ns i m pose d .(v ) If I v io la te t h e c o nditio ns o f c o m munity c u sto dy, t h e B oard m ay r e tu rn m e t o
co n fin em en t. ( g ) If I a m c o nvic te d o f a n y n ew c rim es b efo re s e n te n cin g, o r i f a n y a d ditio nal c rim in al h is to ry
is d is c o vere d , b oth t h e s ta n dard s e n te n ce r a n ge a n d t h e p ro se cu tin g a tto rn ey 's
re co m men datio n m ay i n cre ase . E ven s o , m y p le a o f g uilty t o t h is c h arg e i s b in din g o n m e.
I c an not c h an g e m y m in d i f a d ditio nal c rim in al h is to ry i s d is c o vere d e v en t h ough t h e
sta n dard s e n te n cin g r a n ge a n d t h e p ro se cu ti n g a tto rn ey 's r e co m men datio n i n cre ase o r a
ma n dato ry s e n te n ce o f l if e i m pris o nm en t w ith out t h e p ossib ility o f p aro le i s r e q uir e d b y
law .(h ) In a d ditio n t o s e n te n cin g m e t o c o nfin em en t, t h e j u dge w ill o rd er m e t o p ay $ 500.0 0 a s a
vic tim 's c o m pen sa tio n f u nd a sse ssm en t a n d a n y m an dato ry f in es o r p en altie s t h at a p ply t o
my c ase . I f t h is c rim e r e su lte d i n i n ju ry t o a n y p ers o n o r d am ag e t o o r l o ss o f p ro perty , t h e
ju dge w ill o rd er m e t o m ak e r e stitu tio n, u nle ss e x tr a o rd in ary c ir c u m sta n ces e x is t w hic h
mak e r e stitu tio n i n ap pro pria te . T he a m ount o f r e stitu tio n m ay b e u p t o d ouble m y g ain o r
do uble t h e v ic tim ’s l o ss. T he j u dge m ay a ls o o rd er t h at I p ay a f in e, c o urt c o sts , a tto rn ey
fees, a n d t h e c o sts o f i n carc era tio n. ( i) For c rim es c o m mitte d p rio r t o J u ly 1 , 2 000 : I n a d ditio n t o s e n te n cin g m e t o c o nfin em en t,
t h e j u dge m ay o rd er m e t o s e rv e u p t o o ne y ear o f c o m munity c u sto dy i f t h e t o ta l p erio d o f
co nfin em en t o rd ere d i s n ot m ore t h an 1 2 m onth s. I f t h e t o ta l p erio d o f c o nfin em en t i s m ore
th an 1 2 m onth s, a n d i f t h is c rim e i s a d ru g o ffe n se , a ssa u lt i n t h e s e co nd d eg re e, a ssa u lt o f a
ch ild i n t h e s e co nd d eg re e, o r a n y c rim e a g ain st a p ers o n i n w hic h a s p ecif ic f in din g w as
ma d e t h at I o r a n a cco m plic e w as a rm ed w ith a d ea d ly w eap on, t h e j u dge w ill o rd er m e t o
serv e a t l e ast o ne y ear o f c o m munity c u sto dy. I f t h is c rim e i s a v eh ic u la r h om ic id e,
ve h ic u la r a ssa u lt, o r a s e rio us v io le n t o ffe n se , t h e j u dge w ill o rd er m e t o s e rv e a t l e ast t w o
years o f c o m munity c u sto dy. T he a ctu al p erio d o f c o m munity c u sto dy m ay b e l o nger t h an
my e arn ed e arly r e le ase p erio d. D urin g t h e p erio d o f c o m munity c u sto dy, I w ill b e u nder
th e s u perv is io n o f t h e D ep artm en t o f C orre ctio ns, a n d I w ill h av e r e str ic tio ns a n d
req uir e m en ts p la ced u pon m e.
F or c rim es c o m mitte d o n o r a fte r J u ly 1 , 2 000 : I n a d dit i o n t o s e n te n cin g m e t o
co nfin em en t, u nder c erta in c ir c u m sta n ces t h e j u dge m ay o rd er m e t o s e rv e u p t o o ne y ear
of c o m munity c u sto dy i f t h e t o ta l p erio d o f c o nfin em en t o rd ere d i s n o t m ore t h an 1 2
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 4 of 11CrR 4 .2 (g ) ( 0 8/2 016)m onth s, b ut o nly i f t h e c rim e I h av e b een c o nvic te d o f f a lls i n to o ne o f t h e o ffe n se t y pes
lis te d i n t h e f o llo w in g c h art. F or t h e o ffe n se o f f a ilu re t o r e g is te r a s a s e x o ffe n der,
re g ard le ss o f t h e l e n gth o f c o nfin em en t, t h e j u dge w ill s e n te n ce m e f o r u p t o 1 2 m onth s o f
co m munity c u sto dy. I f t h e t o ta l p erio d o f c o nfin em en t o rd ere d i s m ore t h an 1 2 m onth s,
an d i f t h e c rim e I h av e b een c o nvic te d o f f a lls i n to o ne o f t h e o ffe n se t y pes l is te d i n t h e
fo llo w in g c h art, t h e c o urt w ill s e n te n ce m e t o c o m munity c u sto dy f o r t h e t e rm e sta b lis h ed
for t h at o ffe n se t y pe u nle ss t h e j u dge f in ds s u bsta n ti a l a n d c o m pellin g r e aso ns n o t t o d o s o .
If t h e p erio d o f e arn ed r e le ase a w ard ed p er R CW 9 .9 4A .7 2 9 i s l o nger, t h at w ill b e t h e t e rm
of m y c o m munity c u sto dy. I f t h e c rim e I h av e b een c o nvic te d o f f a lls i n to m ore t h an o ne
ca te g ory o f o ffe n se t y pes l is te d i n t h e f o llo w in g c h art, t h en t h e c o m munity c u sto dy t e rm
wil l b e b ase d o n t h e o ffe n se t y pe t h at d ic ta te s t h e l o ngest t e rm o f c o m munity c u sto dy.O FF E N SE T Y PEC O M MUNIT Y C UST O DY T ER MSerio us V io le n t O ffe n se s3 6 m onth s V io le n t O ffe n se s1 8 m onth s C rim es A gain st P ers o ns a s d efin ed b y R CW
9.9 4 A .4 1 1(2 )12 m onth s O ff e n se s u nder C hap te r 6 9.5 0 o r 6 9.5 2 R CW
(not s e n te n ced u nder R CW 9 .9 4A .6 60)1 2 m onth s O ff e n se s i n volv in g t h e u nla w fu l p osse ssio n o f
a f ir e arm w here t h e o ffe n der i s a c rim in al
st r e et g an g m em ber o r a sso cia te1 2 m onth sC erta in s e n te n cin g a lte rn ativ es m ay a ls o i n clu de c o m munity c u sto dy. D urin g t h e p erio d o f c o m munity c u sto dy I w ill b e u nder t h e s u perv is io n o f t h e D ep artm en t
of C orre ctio ns. F or c rim es o ccu rrin g o n o r a fte r J u ne 2 8, 2 016, t h e s u perv is io n o f t h e
De p artm en t o f C orre ctio ns c an not e x ceed t h e t im es s p ecif ie d i n t h is p ara g ra p h. I m ay h av e
restr ic tio ns a n d r e q uir e m en ts p la ced u pon m e, i n clu din g a d ditio nal c o nditio ns o f
co m munity c u sto dy t h at m ay b e i m pose d b y t h e D ep artm en t o f C orre ctio ns. M y f a ilu re t o
co m ply w ith t h ese c o nditio ns w ill r e n der m e i n elig ib le f o r g en era l a ssis ta n ce, R CW
74.0 4.0 05(6 )(h ), a n d m ay r e su lt i n t h e D ep artm en t o f C orre ctio ns t r a n sfe rrin g m e t o a m ore
restr ic tiv e c o nfin em en t s ta tu s o r o th er s a n ctio ns. If I v io la te t h e c o nditio ns o f m y c o m munity c u sto dy, t h e D ep artm en t o f C orre ctio n s m ay
san ctio n m e u p t o 6 0 d ay s’ c o nfin em en t p er v io la tio n a n d/o r r e v oke m y e arn ed e arly
rele ase , o r t h e D ep artm en t o f C orre ctio ns m ay i m pose a d ditio nal c o nditio ns o r o th er
stip ula te d p en altie s. T he c o urt a ls o h as t h e a u th ority t o i m pose s a n ctio ns f o r a n y v io la tio n.(j) The p ro se cu tin g a tto rn ey w ill m ak e t h e f o llo w in g r e co m men datio n t o t h e j u dge: _ _____ . T he p ro se cu to r w ill r e co m men d a s s ta te d i n t h e p le a a g re em en t, w hic h i s i n co rp ora te d
by r e fe re n ce. (k ) The judge does not have to follow anyone’s recommendation as to sentence. The judge
must impose a sentence within the standard range unless the judge finds substantial and
compelling reasons not to do so. I understand the following regarding exceptional sentences:
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 5 of 11CrR 4 .2 (g ) ( 0 8/2 016)(i) The judge may impose an exceptional sentence below the standard range if the
judge finds mitigating circumstances supporting an exceptional sentence. (ii)The judge may impose an exceptional sentence above the standard range if I am
being sentenced for more than one crime and I have an offender score of more
than nine. (iii)The judge may also impose an exceptional sentence above the standard range if
the State and I stipulate that justice is best served by imposition of an exceptional
sentence and the judge agrees that an exceptional sentence is consistent with and
in furtherance of the interests of justice and the purposes of the Sentencing
Reform Act.(iv)The judge may also impose an exceptional sentence above the standard range if
the State has given notice that it will seek an exceptional sentence, the notice
states aggravating circumstances upon which the requested sentence will be
based, and facts supporting an exceptional sentence are proven beyond a
reasonable doubt to a unanimous jury, to a judge if I waive a jury, or by
stipulated facts.If the court imposes a standard range sentence, then no one may appeal the sentence. If
the court imposes an exceptional sentence after a hearing, either the State or I can appeal
the sentence. (l) If I a m n ot a c itiz en o f t h e U nite d S ta te s, a p le a o f g uilty t o a n o ffe n se p unis h ab le a s a c rim e
un der s ta te l a w i s g ro unds f o r d ep orta tio n, e x clu sio n f ro m a d m is sio n t o t h e U nite d S ta te s,
or d en ia l o f n atu ra liz atio n p urs u an t t o t h e l a w s o f t h e U nite d S ta te s.(m ) I m ay n ot p osse ss, o w n, o r h av e u nder m y c o ntr o l a n y f ir e arm , a n d u nder f e d era l l a w a n y
fir e arm o r a m munitio n, u nle ss m y r ig ht t o d o s o i s r e sto re d b y t h e c o urt i n w hic h I a m
convic te d o r t h e s u perio r c o urt i n W ash in gto n S ta te w here I l iv e, a n d b y a f e d era l c o urt i f
re q uir e d . I m ust i m med ia te ly s u rre n der a n y c o nceale d p is to l l ic en se . ( n ) I w ill b e ineligible to vote until that right is restored in a manner provided by law. If I am
registered to vote, my voter registration will be cancelled. Wash. Const. art. VI, § 3,
RCW 29A.04.079; RCW 29A.08.520.(o ) Govern m en t a ssis ta n ce m ay b e s u sp en ded d urin g a n y p erio d o f c o nfin em en t.( p ) I w ill b e r e q uir e d t o h av e a b io lo gic al s a m ple c o lle c te d f o r p urp ose s o f D NA i d en tif ic atio n
analy sis . I w ill b e r e q uir e d t o p ay a $ 100 .0 0 D NA c o lle ctio n f e e.Notification Relating to Specific Crimes : If any of the following paragraphs DO NOT
APPLY, counsel and the defendant shall strike them out. The defendant and the judge
shall initial all paragraphs that DO APPLY.___ __ (q ) This o ffe n se i s a m ost s e rio us o ffe n se o r “ str ik e” a s d efin ed b y R CW 9 .9 4A .0 30, a n d i f I
ha v e a t l e ast t w o p rio r c o nvic tio ns f o r m ost s e rio us o ffe n se s, w heth er i n t h is s ta te , i n f e d era l
co urt, o r e ls e w here , t h e c rim e f o r w hic h I a m c h arg ed c arrie s a m an dato ry s e n te n ce o f l if e
im pris o nm en t w ith out t h e p ossib ility o f p aro le . _ __ __ (r) The j u dge m ay s e n te n ce m e a s a f ir s t- tim e o ffe n der i n ste ad o f g iv in g a s e n te n ce w ith in t h e
sta n dard r a n ge i f I q ualif y u nder R CW 9 .9 4A .0 30. T his s e n te n ce c o uld i n clu de a s m uch a s
90 d ay s' c o nfin em en t a n d u p t o o ne y ear o f c o m munity c u sto dy p lu s a ll o f t h e c o nditio ns
de sc rib ed i n p ara g ra p h 6 (h ). A dditio nally , t h e j u dge c o uld r e q uir e m e t o u nderg o
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 6 of 11CrR 4 .2 (g ) ( 0 8/2 016)tr e a tm en t, t o d ev ote t im e t o a s p ecif ic o ccu patio n, a n d t o p urs u e a p re sc rib ed c o urs e o f
stu d y o r o ccu patio nal t r a in in g. _ __ __ (s ) The j u dge m ay s e n te n ce m e u nder t h e P are n tin g S en te n cin g A lte rn ativ e i f I q ualif y u nder
RC W 9 .9 4A .6 55 . I f I a m e lig ib le , t h e j u dge m ay o rd er D OC t o c o m ple te e ith er a r is k
asse ssm en t r e p ort o r a c h em ic al d ep en den cy s c re en in g r e p ort, o r b oth . I f t h e j u dge d ecid es
to i m pose t h e P are n tin g S en te n cin g A lte rn ativ e, t h e s e n te n ce w ill c o nsis t o f 1 2 m onth s o f
co m munity c u sto dy a n d I w ill b e r e q uir e d t o c o m ply w ith t h e c o nditio ns i m pose d b y t h e
co urt a n d b y D OC. A t a n y t im e d urin g c o m munity c u sto dy, t h e c o urt m ay s c h ed ule a
he arin g t o e v alu ate m y p ro gre ss i n t r e atm en t o r t o d ete rm in e i f I h av e v io la te d t h e
co nditio ns o f t h e s e n te n ce. T he c o urt m ay m odif y t h e c o nditio ns o f c o m munity c u sto dy o r
im pose s a n ctio ns. I f t h e c o urt f in ds I v io la te d t h e c o nditio ns o r r e q uir e m en ts o f t h e
se n te n ce o r I f a ile d t o m ak e s a tis fa cto ry p ro gre ss i n t r e atm en t, t h e c o urt m ay o rd er m e t o
serv e a t e rm o f t o ta l c o nfin em en t w ith in t h e s ta n dard r a n ge f o r m y o ffe n se ._ __ __ (t) If t h is c rim e i n volv es k id nap pin g i n volv in g a m in or, i n clu din g u nla w fu l i m pris o nm en t
in volv in g a m in or w ho i s n ot m y c h ild , o r i f t h is c rim e i s p ro m otin g p ro stitu tio n i n t h e f ir s t
or s e co nd d eg re e a n d I h av e a t l e ast o ne p rio r c o nvic tio n f o r p ro m otin g p ro stitu tio n i n t h e
fir s t o r s e co nd d eg re e, o r i f t h is c rim e i s ( h u m an ) t r a ffic k in g i n t h e f ir s t d eg re e u nder
RC W 9 A .4 0.1 00(1 )(a )(i) (A )(III) o r ( IV ) o r ( 1 )(a )(i) (B ) ( re la tin g t o s e x ually e x plic it a cts o r
co m merc ia l s e x a cts ), I w ill b e r e q uir e d t o r e g is te r w here I r e sid e, s tu dy , o r w ork . T he
sp ecif ic r e g is tr a tio n r e q uir e m en ts a re s e t f o rth i n t h e “ O ffe n der R eg is tr a tio n” A tta ch m en t. _ __ __ (u ) If t h is i s a c rim e o f d om estic v io le n ce, I m ay b e o rd ere d t o p ay a d om estic v io le n ce
asse ssm en t o f u p t o $ 115.0 0. I f I , o r t h e v ic tim o f t h e o ffe n se , h av e a m in or c h ild , t h e c o urt
ma y o rd er m e t o p artic ip ate i n a d om estic v io le n ce p erp etr a to r p ro gra m a p pro ved u nder
RC W 2 6.5 0.1 5 0. If I am convicted under RCW 26.50.110 for a violation of a domestic
violence protection order issued under chapter 26.50 RCW, the court shall impose a
mandatory fine of $15.00. ___ __ (v ) If t h is c rim e i n volv es p ro stitu tio n, o r a d ru g o ffe n se a sso cia te d w ith h ypoderm ic n eed le s, I
will b e r e q uir e d t o u nderg o t e stin g f o r t h e h u m an i m munodefic ie n cy ( H IV /A ID S) v ir u s._ __ __ (w ) The j u dge m ay s e n te n ce m e u nder t h e d ru g o ffe n der s e n te n cin g a lte rn ati v e ( D OSA ) i f I
qu alif y u nder R CW 9 .9 4A .6 60. I f I q ualif y a n d t h e j u dge i s c o nsid erin g a r e sid en tia l
ch em ic al d ep en den cy t r e atm en t- b ase d a lte rn ativ e, t h e j u dge m ay o rd er t h at I b e e x am in ed
by D OC b efo re d ecid in g t o i m pose a D OSA s e n te n ce. I f t h e j u dge d ecid es t o i m pose a
DO SA s e n te n ce, i t c o uld b e e ith er a p ris o n-b ase d a lte rn ativ e o r a r e sid en tia l c h em ic al
de p en den cy t r e atm en t- b ase d a lte rn ativ e.If t h e j u d ge i m pose s t h e p ris o n -b ase d a lt e rn ativ e, t h e s e n te n ce w ill c o nsis t o f a p erio d o f
to ta l c o n fin em en t i n a s ta te f a cility f o r o ne-h alf o f t h e m id poin t o f t h e s ta n dard r a n ge, o r 1 2
mo nth s, w hic h ev er i s g re ate r. D urin g c o nfin em en t, I w ill b e r e q uir e d t o u nderg o a
co m pre h en siv e s u bsta n ce a b use a sse ssm en t a n d t o p arti c ip ate i n t r e a tm en t. T he j u dge w ill
al s o i m po se a t e rm o f c o m munity c u sto dy o f o ne-h alf o f t h e m id poin t o f t h e s ta n dard r a n ge. If t h e j u dge i m pose s t h e r esid en tia l c h em ic a l d ep en den cy t r ea tm en t-b ase d a lt e rn ativ e,
th e s e n te n ce w ill c o nsis t o f a t e rm o f c o m m unity c u sto dy e q ual t o o ne-h alf o f t h e m id poin t
of t h e s ta n dard s e n te n ce r a n ge o r t w o y ears , w hic h ev er i s g re ate r, a n d I w ill h av e t o e n te r
an d r e m ain i n a c ertif ie d r e sid en tia l c h em ic al d ep en den cy t r e atm en t p ro gra m f o r a p erio d o f
th re e t o s ix m on th s, a s s e t b y t h e c o u rt.
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 7 of 11CrR 4 .2 (g ) ( 0 8/2 016) A s p art o f t h is s e n te n cin g a lte rn ativ e, t h e c o urt i s r e q uir e d t o s c h ed ule a p ro gre ss h earin g
durin g t h e p erio d o f r e sid en tia l c h em ic al d ep en den cy t r e atm en t a n d a t r e atm en t t e rm in atio n
hearin g s c h ed u le d t h re e m onth s b efo re t h e e x pir a tio n o f t h e t e rm o f c o m munity c u sto dy.
At e ith er h earin g , b ase d u pon r e p orts b y m y t r e atm en t p ro vid er a n d t h e D ep artm en t o f
Co rre ctio ns o n m y c o m plia n ce w ith t r e atm en t a n d m onito rin g r e q uir e m en ts a n d
reco m men datio ns r e g ard in g t e rm in atio n f ro m t r e atm en t, t h e j u dge m ay m odif y t h e
co nditio ns o f m y c o m munity c u sto dy o r o rd er m e t o s e rv e a t e rm o f total confinement
equal to one-half of the midpoint of the standard sentence range, followed by a term of
community custody under RCW 9.94A.701.During the term of community custody for either sentencing alternative, the judge could
prohibit me from using alcohol or controlled substances, require me to submit to
urinalysis or other testing to monitor that status, require me to devote time to a specific
employment or training, stay out of certain areas, pay $30.00 per month to offset the cost
of monitoring and require other conditions, such as affirmative conditions, and the
conditions described in paragraph 6(h). The judge, on his or her own initiative, may
order me to appear in court at any time during the period of community custody to
evaluate my progress in treatment or to determine if I have violated the conditions of the
sentence. If the court finds that I have violated the conditions of the sentence or that I
have failed to make satisfactory progress in treatment, the court may modify the terms of
my community custody or order me to serve a term of total confinement within the
standard range. ___ __ (x ) If I a m s u bje ct t o c o m munity c u sto dy a n d t h e j u dge f in ds t h at I h av e a c h em ic al
de p en den cy t h at h as c o ntr ib ute d t o t h e o ffe n se , t h e j u dge m ay o rd er m e t o p artic ip ate i n
reh ab ilita tiv e p ro gra m s o r o th erw is e t o p erf o rm a ffir m ativ e c o nduct r e aso nab ly r e la te d t o
th e c ir c u m sta n ces o f t h e c rim e f o r w hic h I a m p le ad in g g uilty . R eh ab ilita tiv e p ro gra m s
ma y i n clu de a n o rd er t o o bta in a n e v alu atio n f o r a lc o hol o r c o ntr o lle d s u bsta n ce c h em ic al
de p en den cy t r e atm en t. T he c o urt m ay a ls o p ro hib it m e f ro m p osse ssin g o r c o nsu m in g
alc o hol o r c o n tr o lle d s u bsta n ces w ith out a v alid p re sc rip tio n. _ __ __ (y ) If t h is c rim e i n volv es t h e m an ufa ctu re , d eliv ery , o r p osse ssio n w ith t h e i n te n t t o d eliv er
me th am pheta m in e, i n clu din g i ts s a lts , i s o m ers , a n d s a lts o f i s o m ers , o r a m pheta m in e,
in clu din g i ts s a lts , i s o m ers , a n d s a lts o f i s o m ers , a n d i f a f in e i s i m pose d , $ 3,0 00 o f t h e f in e
may n ot b e s u sp en ded . R CW 6 9.5 0.4 01 (2 )(b )._ __ __ (z ) If t h is c rim e i n volv es a violation of the state drug laws, my eligibility for state and federal
food stamps, welfare, and education benefits may be affected. 20 U.S.C. § 1091(r);
21 U.S.C. § 862a.___ __ (a a ) I unders ta n d that RCW 46.20.285(4) requires that my driver’s license be revoked if the
judge finds I used a motor vehicle in the commission of this felony.___ __ (b b) I unders ta n d that RCW 46.20.265 requires that my driver’s license be revoked if (a) the
current offense is a violation under RCW chapter 69.41 [Legend drug], 69.50 [VUCSA],
or 69.52 [Imitation drugs], and I was under the age of 21 at the time of the offense OR
(b) the current offense is a violation under RCW 9.41.040 (unlawful possession of
firearm), and I was under the age of 18 at the time of the offense OR (c) the current
offense is a violation under RCW chapter 66.44 [Alcohol] and I was under the age of 18
at the time of the offense, AND if (a), (b), or (c) applies, the court finds that I previously
committed an offense while armed with a firearm, an unlawful possession of a firearm
offense, or an offense in violation of chapter 66.44, 69.41, 69.50, or 69.52 RCW.
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 8 of 11CrR 4 .2 (g ) ( 0 8/2 016)___ __ (c c ) If t h is c rim e i n volv es t h e o ffe n se o f v eh ic u la r h om ic id e w hile u nder t h e i n flu en ce o f
in to xic atin g l iq uor, o r a n y d ru g, a s d efin ed b y R CW 4 6.6 1.5 20 , a n i m pair e d d riv in g
en han cem en t o f a n a d ditio nal t w o y ears s h all b e a d ded t o t h e s ta n dard s e n te n ce r a n ge f o r
ve h ic u la r h om ic id e f o r e ach p rio r o ffe n se a s d efin ed i n R CW 4 6.6 1.5 055(1 4 ). A ll i m pair e d
driv in g e n han cem en ts a re m an dato ry , s h all b e s e rv ed i n t o ta l c o nfin em en t, a n d s h all r u n
co nse cu tiv ely t o a ll o th er s e n te n cin g p ro vis io ns, i n clu din g o th er i m pair e d d riv in g
en han cem en ts , f o r a ll o ffe n se s s e n te n ced u nder C hap te r 9 .9 4A R CW .___ __ (d d) If I am pleading guilty to felony driving under the influence of intoxicating liquor, or any
drugs, or felony actual physical control of a motor vehicle while under the influence of
intoxicating liquor, or any drug, in addition to the provisions of chapter 9.94A RCW, I
will be required to undergo alcohol or chemical dependency treatment services during
incarceration. I will be required to pay the costs of treatment unless the court finds that I
am indigent. My driving privileges will be suspended, revoked or denied. Following the
period of suspension, revocation, or denial, I must comply with the Department of
Licensing ignition interlock device requirements. In addition to any other costs of the
ignition interlock device, I will be required to pay an additional fee of $20 per month._____(ee)For the crimes of vehicular homicide committed while under the influence of intoxicating
liquor, or any drug as defined by RCW 46.61.520 or for vehicular assault committed
while under the influence of intoxicating liquor, or any drug as defined by RCW
46.61.522, or for any felony driving under the influence (RCW 46.61.502(6)), or felony
physical control under the influence (RCW 46.61.504(6)), the court shall add 12 months
to the standard sentence range for each child passenger under the age of 16 who is an
occupant in the defendant's vehicle. These enhancements shall be mandatory, shall be
served in total confinement, and shall run consecutively to all other sentencing
provisions. _____ (ff)I am pleading guilty to the crime of driving without a required ignition interlock device
(RCW 46.20.740), or the crime of circumventing or tampering with a required ignition
interlock device (RCW 46.20.750(1)), and the offense occurred on or after September 26,
2015. The sentence for that offense must be served consecutively with any other
sentence imposed for violations of either of those statutes and with any sentence imposed
under RCW 46.61.502 (DUI), RCW 46.61.504 (physical control under the influence), or
RCW 46.61.5055. The sentence for violation of RCW 46.20.750(1) also must be served
consecutively with any sentence imposed under RCW 46.61.520(1)(a) or 46.61.522(1)(b)
(vehicular homicide/assault while under the influence of alcohol/drugs). _____(gg)For the crimes of felony driving under the influence of intoxicating liquor, or any drug,
for vehicular homicide while under the influence of intoxicating liquor, or any drug, or
vehicular assault while under the influence of intoxicating liquor, or any drug, the court
may order me to reimburse reasonable emergency response costs up to $2,500 per
incident. ___ __ (h h) The c rim e o f _ _______________________________ h as a m an dato ry m in im um s e n te n ce
of a t l e ast _ ______ y ears o f t o ta l c o nfin em en t. T his l a w d oes n ot a p ply t o c rim es
co m mitte d o n o r a fte r J u ly 2 4, 2 005, b y a j u ven ile w ho w as t r ie d a s a n a d ult a fte r d eclin e o f
ju ven ile c o urt j u ris d ic tio n. T he l a w d oes n ot a llo w a n y r e d uctio n o f t h is s e n te n ce. T his
ma n dato ry m in im um s e n te n ce i s n ot t h e s a m e a s t h e m an dato ry s e n te n ce o f l if e
im pris o nm en t w ith out t h e p ossib ility o f p aro le d esc rib ed i n p ara g ra p h 6 (q ).
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 9 of 11CrR 4 .2 (g ) ( 0 8/2 016)___ __ (ii) I a m b ein g s e n te n ced f o r t w o o r m ore s e rio us v io le n t o ffe n se s a ris in g f ro m s e p ara te a n d
dis tin ct c rim in al c o nduct a n d t h e s e n te n ces i m pose d o n c o unts _ ____ a n d _ ____ w ill ru n
co nse cu tiv ely u nle ss t h e j u dge f in ds s u bsta n tia l a n d c o m pellin g r e aso ns t o d o o th erw is e ._ __ __ (jj) The o ffe n se (s ) I a m p le ad in g g uilty t o i n clu de(s ) a V io la tio n o f t h e U nif o rm C ontr o lle d
Substa n ces A ct i n a p ro te cte d z o ne e n han cem en t o r m an ufa ctu re o f m eth am pheta m in e
wh en a j u ven ile w as p re se n t i n o r u pon t h e p re m is e s o f m an ufa ctu re e n han cem en t. I
un ders ta n d t h ese e n han cem en ts a re m an dato ry a n d t h at t h ey m ust r u n c o nse cu tiv ely t o a ll
oth er s e n te n cin g p ro vis io ns._ __ __ (k k) The o ffe n se (s ) I a m p le ad in g g uilty t o i n clu de(s ) a d ead ly w eap on, f ir e arm , o r s e x ual
mo tiv atio n e n han cem en t. D ead ly w eap on, f ir e arm , o r s e x ual m otiv atio n e n han cem en ts a re
man dato ry , t h ey m ust b e s e rv ed i n t o ta l c o nfin em en t, a n d t h ey m ust r u n c o nse cu tiv ely t o
an y o th er s e n te n ce a n d t o a n y o th er d ead ly w eap on, f ir e arm , o r s e x ual m otiv atio n
en han cem en ts ._ __ __ (ll) If I am pleading guilty to (1) unlawful possession of a firearm(s) in the first or second
degree and (2) felony theft of a firearm or possession of a stolen firearm, I am required to
serve the sentences for these crimes consecutively to one another. If I am pleading guilty
to unlawful possession of more than one firearm, I must serve each of the sentences for
unlawful possession consecutively to each other.___ __ (m m) If I a m p le ad in g g uilty t o a f e lo ny f ir e arm o ffe n se a s d efin ed i n R CW 9 .4 1.0 10, I m ay b e
re q uir e d t o r e g is te r a s a f e lo ny f ir e arm o ffe n der u nder R CW 9 .4 1 .3 30 . I will be required to
register as a felony firearm offender if I committed the felony firearm offense in
conjunction with an offense committed against a person under age 18, or a serious violent
offense or offense involving sexual motivation as defined in RCW 9.94A.030. T he
sp ecif ic r e g is tr a tio n r e q uir e m en ts a re i n t h e “ F elo ny F ir e arm O ffe n der R eg is tr a tio n”
Atta ch m en t._ __ __ (n n) If I am pleading guilty to the crime of unlawful practices in obtaining assistance as
defined in RCW 74.08.331, no assistance payment shall be made for at least six months if
this is my first conviction and for at least 12 months if this is my second or subsequent
conviction. This suspension of benefits will apply even if I am not incarcerated. RCW
74.08.290._____ (oo)The judge may authorize work ethic camp. To qualify for work ethic authorization my
term of total confinement must be more than 12 months and less than 36 months, I cannot
currently be either pending prosecution or serving a sentence for violation of the Uniform
Controlled Substances Act, and I cannot have a current or prior conviction for a sex or
violent offense.7. I p le ad g uilty t o : co unt c o unt c o unt i n t h e _ _______________________ I n fo rm atio n. I h av e r e ceiv ed a c o py o f t h at I n fo rm atio n.
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 10 of 11CrR 4 .2 (g ) ( 0 8/2 016)8. I m ak e t h is p le a f re ely a n d v olu nta rily .9 . No o ne h as t h re ate n ed h arm o f a n y k in d t o m e o r t o a n y o th er p ers o n t o c au se m e t o m ak e t h is p le a.1 0. No p ers o n h as m ad e p ro m is e s o f a n y k in d t o c au se m e t o e n te r t h is p le a e x cep t a s s e t f o rth i n t h is
sta te m en t.1 1. The j u dg e h as a sk ed m e t o s ta te w hat I d id i n m y o w n w ord s t h at m ak es m e g uilty o f t h is c rim e.
Th is i s m y s ta te m en t: . I n ste ad o f m ak in g a s ta te m en t, I a g re e t h at t h e c o urt m ay r e v ie w t h e p olic e r e p orts a n d/o r a
sta te m en t o f p ro bab le c au se s u pplie d b y t h e p ro se cu tio n t o e sta b lis h a f a ctu al b asis f o r t h e p le a. 1 2. My l a w yer h as e x pla in ed t o m e, a n d w e h av e f u lly d is c u sse d , a ll o f t h e a b ove p ara g ra p hs a n d t h e
“O ffe n der R eg is tr a tio n” A tta ch m en t, i f a p plic ab le . I u nders ta n d t h em a ll. I h av e b een g iv en a c o py
of t h is “ S ta te m en t o f D efe n dan t o n P le a o f G uilty .” I h av e n o f u rth er q uestio ns t o a sk t h e j u dge. D efe n dan tI h av e r e ad a n d d is c u sse d t h is s ta te m en t w ith t h e
de fe n dan t. I b elie v e t h at t h e d efe n dan t i s
co m pete n t a n d f u lly u nders ta n ds t h e s ta te m en t. P ro se cu tin g A tto rn ey Defe n dan t's L aw yer P rin t N am e WSB A N o. Prin t N am e WSB A N o.T he d efe n dan t s ig ned t h e f o re g oin g s ta te m en t i n o pen c o urt i n t h e p re se n ce o f t h e d efe n dan t's l a w yer a n d t h e
un d ers ig n ed j u d ge. T he d efe n dan t a sse rte d t h at [ c h eck a p pro pria te b ox]: ( a ) The d efe n dan t h ad p re v io usly r e ad t h e e n tir e s ta te m en t a b ove a n d t h at t h e d efe n dan t u nders to od i t
in f u ll; ( b ) The d efe n dan t's l a w yer h ad p re v io usly r e ad t o h im o r h er t h e e n tir e s ta te m en t a b ove a n d t h at t h e
de fe n dan t u nders to od i t i n f u ll; o r ( c ) An i n te rp re te r h ad p re v io usly r e ad t o t h e d efe n dan t t h e e n tir e s ta te m en t a b ove a n d t h at t h e
de fe n dan t u nders to od i t i n f u ll. T he I n te rp re te r’s D ecla ra tio n i s i n clu ded b elo w .
Sta te m en t o n P le a o f G uilt y ( N on-S ex O ffe nse ) ( S TTD FG ) - Page 11 of 11CrR 4 .2 (g ) ( 0 8/2 016)In te rp re te r’s D ecla ra tio n : I a m a c ertif ie d o r r e g is te re d i n te rp re te r, o r h av e b een f o und o th erw is e q ualif ie d
by t h e c o urt t o i n te rp re t i n t h e _ ________________________ ________ l a n guag e, w hic h t h e d efe n dan t
un d ers ta n ds. I h av e i n te rp re te d t h is d ocu m en t f o r t h e d efe n d an t f ro m E nglis h i n to t h at l a n guag e. I c ertif y
un d er p en alty o f p erju ry u nder t h e l a w s o f t h e s ta te o f W ash in gto n t h at t h e f o re g oin g i s t r u e a n d c o rre ct.S ig ned a t ( c ity ) _ ___________________ , ( s ta te ) _ ________ ______ , o n ( d ate ) _ _______________ .___ ___ _________________________________ _ __________ ________________________ _In te rp re te r Prin t N am eI f in d t h e d efe n dan t's p le a o f g uilty t o b e k now in gly , i n te llig en tly a n d v olu nta rily m ad e. D efe n dan t
un d ers ta n ds t h e c h arg es a n d t h e c o nse q uen ces o f t h e p le a. T here i s a f a ctu al b asis f o r t h e p le a. T he
defe n dan t i s g uilty a s c h arg ed .D ate d : J u dge
